Valvular interventions: Identifying need and improving outcomes in primary care

Mitral and tricuspid valve disease is more common than most patients—and even some clinicians—realize. As transcatheter options continue to evolve, primary care providers play a critical role in recognizing symptoms early and helping patients access treatments that previously weren’t available or safe for them.

Nebraska Medicine now offers a wide range of minimally invasive mitral and tricuspid therapies that can make a meaningful difference, particularly for older adults and those with multiple comorbidities. 

In this article, interventional cardiologist Marvin Eng, MD FACC FSCAI outlines the key conditions primary care providers should recognize, when to refer, and what the future landscape of valvular interventions looks like. 

What primary care providers see: Identifying symptomatic valve disease early

Mitral and tricuspid valve dysfunction often present subtly in primary care. Early recognition can significantly change a patient’s prognosis—especially as transcatheter options expand.

PCPs are most likely to encounter patients with:

• Shortness of breath or exertional intolerance.
• Heart failure symptoms, including swelling, abdominal bloating or rapid weight gain.
• Unexplained fatigue, particularly in older adults.
• Rarely, hemolysis in cases of post-surgical valve failure.

These symptoms may emerge in patients with a history of valve surgery, in those with progressive degenerative valve disease or in patients whose comorbidities make open surgery high-risk. 

“It’s better to refer early when people have mild symptoms than to wait until hospitalization,” Dr. Eng emphasizes. “Earlier referral tends to result in safer procedures, smoother recoveries and better long-term outcomes.”

Current mitral and tricuspid interventions 

Nebraska Medicine offers one of the region’s most robust structural heart programs, providing expertise in both repair and replacement using transcatheter approaches.

Mitral valve therapies

• Transcatheter edge-to-edge repair (TEER / MitraClip):
  Used for mitral valve regurgitation, this minimally invasive technique approximates the leaflets to reduce leakage.
• Transcatheter mitral valve replacement (TMVR):
  A next-generation valve is expected within the next year and will allow full valve replacement in the mitral position. Nebraska Medicine anticipates early adoption of this technology.
• Balloon mitral valvuloplasty: 
  Used in selected cases of mitral stenosis to provide temporary symptomatic relief.
• Treatment of post-surgical failures:
  For failing surgical repairs or bioprosthetic valves, transcatheter replacement can avoid the need for repeat surgery. 

Tricuspid valve therapies

• Tricuspid edge-to-edge repair (TriClip):
  Useful for tricuspid regurgitation in patients who are not surgical candidates.
• Transcatheter tricuspid valve replacement (Evoque System):
  Nebraska Medicine recently performed the first Evoque valve procedure in the state, offering a replacement option for severe tricuspid regurgitation.
• Treatment for rare tricuspid stenosis:
  Although uncommon, transcatheter valve replacement is available when needed.
• Treatment for post-tricuspid surgery failures:
  Transcatheter options exist for failed tricuspid valve replacements and repairs.

Why these options matter: Expanding treatment for high-risk and older patients

Many patients with severe valve disease are elderly or have multiple comorbidities, making open surgery unsafe. Minimally invasive procedures offer:

• Reduced procedural risk.
• Avoidance of sternotomy.
• Faster recovery and shorter hospital stays.
• More treatment options for frail or medically complex patients.

Nebraska Medicine’s multidisciplinary valve program brings together interventional cardiology, cardiac imaging, heart failure specialists and cardiac surgeons to evaluate patients collectively and determine the best therapeutic path. 

Referral process: What PCPs can expect

Patients referred for evaluation undergo a coordinated and streamlined assessment process that includes:

1. Initial visit with both an interventional cardiologist and a cardiac surgeon.
2. Comprehensive imaging, which may include:
   • Transthoracic echocardiogram.
   • Transesophageal echocardiogram.
   • Cardiac CT for structural detail.
   • Heart catheterization (when indicated).
3. Multidisciplinary case review with all relevant specialists.
4. Follow-up call or visit to discuss findings and recommended interventions.

This structure ensures that patients do not undergo unnecessary procedures and that all therapeutic pathways—medical, surgical and transcatheter—are considered. 

Recovery and outcomes

Transcatheter procedures typically require only small access-site punctures, often through the groin. Patients benefit from:

• Rapid recovery.
• Minimal post-operative discomfort.
• Short hospital stays.
• Improved quality of life when symptoms are addressed early.

“Patients are usually home in a short amount of time,” notes Dr. Eng, reflecting the efficiency and safety of these interventions. 

The future landscape: Where mitral and tricuspid interventions are headed

The next several years will likely bring:

• Expansion of transcatheter eligibility to include lower-risk patients.
• FDA approval of new TMVR systems, including the M3 valve.
• Access to investigational valves and ongoing clinical trials.
• Iterative improvements in device design, leveraging experience from aortic TAVR therapies.
• Continued growth of Nebraska Medicine’s role as a regional center for complex structural valve disease.

As research evolves, PCPs will increasingly see patients who qualify for these options—highlighting the importance of early detection and referral.

Key takeaways for primary care providers

1. Recognize early symptoms of mitral and tricuspid valve disease—especially subtle signs of heart failure.
2. Refer early, before hospitalization or advanced decompensation.
3. Consider transcatheter options for elderly or high-risk patients who are poor surgical candidates.
4. Leverage Nebraska Medicine’s multidisciplinary team to guide patient selection and treatment.
5. Stay aware of rapidly evolving technologies that may open treatment pathways for previously untreatable patients.